Medical malpractice as reflected by the forensic evaluation of 4450 autopsies

A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases.     

Retrieving the ‘subject’ of European integration

In this article, a critical reinterpretation of citizens as subjects of European integration moves the focus of EU law from EU citizens' subjection to their subjectification. This analysis draws on post‐structural social theory in arguing that the law is instrumental to securing the material conditions for transnational political subjectification because it regulates both EU citizens' access to transnational social relations and the perception of difference between them. However, the law also reinforces constraints on the process of transnational subjectification. Systematic obstacles, which must be taken into account, are not limited to economic status, but include other variables like gender or age. It will be argued on this basis that EU law needs to develop a more coherent politics of subjectivity. Towards this goal, the law must carefully attend to what is (and is not) depoliticising in EU citizenship rights.     

Youth participation informing care in hospital settings

Abstract

In this article, we use an ecocultural framework to understand young people’s experiences of the care provided by a specialist children’s hospital. This framework conceptualizes hospital culture as situated and embodied rather than separate from people and practices. Young people’s responses, gathered during a one-day forum at the hospital, suggest ways in which a hospital can respond to them not just as individual bodies but also as members of the families and peer groups who form their broader web of care. Their input highlights the importance of consulting young people about the operations of health services themselves, not just about the patient-medico relationships that they experience whilst using a service.     

Vertical influence or horizontal coordination? The purpose of intergovernmental councils in Switzerland

ABSTRACT

In 1993, the Swiss cantons established the conference of cantonal governments (KdK). While the literature on Swiss federalism generally acknowledges the important role of the KdK, little is known about its specific purpose, in particular compared to other, older intergovernmental councils operating in Switzerland. We therefore investigate the purpose of the KdK and contrast it with two other intercantonal conferences with nationwide scope, namely those on education and finance. To do so, we trace two of the most important federal reform processes of the last decade: the latest renewal of fiscal equalization and educational harmonization. We find a division of labour between the KdK and policy-specific councils. While the former aims at vertical political influence, the latter primarily engage in genuine horizontal policy coordination. This flexible and smooth interplay of the two types of councils has contributed to further strengthening the political role of the cantons in the Swiss federation.     

Transnational Partnerships: Conditions for Successful Service Provision in Areas of Limited Statehood

Transnational public–private partnerships (PPPs) are external governance actors in the field of development cooperation and vary in composition, potentially including nonprofit and for‐profit organizations, state and public agencies, and intergovernmental organizations. This article analyzes the conditions under which PPPs have been successful in providing access to basic services (water, sanitation, and food) in areas of limited statehood in Bangladesh, India, and Kenya. We focus on 10 projects carried out by two PPPs that differ in two key respects: legitimacy and institutional design. We show that partnerships with high empirical legitimacy and an appropriate institutional design are best able to fulfill complex tasks in contexts of limited statehood. A participatory approach can promote legitimacy and thus success; projects that lack legitimacy are prone to failure. Additionally, a project's institutional design must address problems that commonly affect areas of limited statehood: It should provide access to resources for capacity development, ensure adequate monitoring, and be tailored to local needs.     

Realities of Victim Participation: The civil party system in practice at the Extraordinary Chambers in the Courts of Cambodia (ECCC)

Victims of the Khmer Rouge play a unique role at the Extraordinary Chambers in the Courts of Cambodia (ECCC) since they have broad participatory rights. However, as the initial trial progressed, a number of changes were made to the framework of victim participation to deal with emerging problems. Although these amendments seemed to curtail some rights, they were also meant to strengthen victim participation and ensure a more efficient trial process. This led to the introduction of restorative justice measures, a lead co-lawyer system and a single submission for reparations. The reasons they were introduced and how they have been implemented so far in the first year of the second trial are the focus here. Subsequently, the impact of the lack of resources and attention given to victim support at the ECCC, from its inception, and the crucial contribution of civil society organizations in filling this gap and carrying out myriad activities at all stages of the participation process are examined. With the well-publicized controversies at the ECCC such as alleged political interference, the participation of victims has the potential to be the lasting legacy of the Court, but any success in this area owes a great debt to Cambodian civil society.     

Tiermisshandlungen wegen “baulicher Mängel” in Schlachtbetrieben – eine strafrechtliche Betrachtung

Natur und Recht - In den letzten Jahren häufen sich Aufdeckungen von schweren Tiermisshandlungen durch Schlachthofmitarbeiter. Grund für diese Taten sind nicht zwingend sadistische...     

A fatal doxepin poisoning associated with a defective CYP2D6 genotype

It has been suggested that the polymorphism of the CYP2D6 gene can contribute to occurrence of fatal adverse effects. We therefore investigated postmortem toxicology cases of fatal drug poisonings related to CYP2D6 substrates, with the manner of death denoted as accidental or undetermined. CYP2D6 genotypes were determined in 11 consecutive cases with samples available for DNA analysis. A case of fatal doxepin poisoning with an undetermined manner of death was found to coincide with a completely nonfunctional CYP2D6 genotype (*3/*4), indicating a total absence of CYP2D6 enzyme and suggesting a poor metabolizer phenotype. The doxepin concentration was 2.4 mg/L, the concentration of nordoxepin 2.9 mg/L, and the doxepin/nordoxepin ratio 0.83, the lowest found among the 35 nordoxepin-positive postmortem cases analyzed during the same year. No alcohols or other drugs were detected in the case. The CYP2C19 genotype was determined as that of an extensive metabolizer. The high N-desmethylmetabolite concentration is not consistent with acute intoxication. It is therefore probable that the defective genotype has contributed to the death, possibly involving repeated high dosage of doxepin. Our case strongly emphasizes that a pharmacogenetic analysis in postmortem forensic setting may reveal new insight to the cause or manner of death.